Provider Demographics
NPI:1871717900
Name:YOUTH SERVICES FOR STEPHENS COUNTY,INC./
Entity type:Organization
Organization Name:YOUTH SERVICES FOR STEPHENS COUNTY,INC./
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-255-8800
Mailing Address - Street 1:PO BOX 1603
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73534-1603
Mailing Address - Country:US
Mailing Address - Phone:580-255-8800
Mailing Address - Fax:580-255-8842
Practice Address - Street 1:16 S 7TH ST
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-4940
Practice Address - Country:US
Practice Address - Phone:580-255-8800
Practice Address - Fax:580-255-8842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1871717900Medicaid